What types of Medicare audits do dermatology practices face?

Dermatology practices face RAC (Recovery Audit Contractor), CERT (Comprehensive Error Rate Testing), MAC (Medicare Administrative Contractor), and UPIC (Unified Program Integrity Contractor) audits. Common triggers include high-volume destruction codes, frequent use of modifier -25, and elevated E/M levels relative to peers.

How can dermatology practices prepare for a Medicare audit?

Proactive preparation includes quarterly internal chart audits, documentation improvement plans, LCD compliance monitoring, modifier usage analysis, and peer comparison benchmarking. Master Billing provides pre-audit readiness assessments and full ALJ-level appeal defense.

Audit Types We Defend

Every audit type,
every level of appeal.

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RAC (Recovery Audit Contractor)

Automated and complex medical review of claims submitted within the last 3 years. High frequency for derm practices billing Mohs, skin substitutes, and E/M services. We respond with clinical documentation packages designed to withstand technical and clinical scrutiny.

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UPIC (Unified Program Integrity Contractor)

The most serious audit type — UPIC investigations can lead to prepayment review, program exclusion, and referral to OIG. We provide documentation alignment audits before they request records and manage the full response process if a UPIC investigation begins.

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MAC Targeted Reviews

Medicare Administrative Contractors conduct periodic targeted reviews of high-utilization codes. Dermatology practices are regularly targeted for Mohs, skin substitutes, and biopsies. We conduct proactive LCD compliance checks to reduce targeting probability.

Our Defense Approach

Pre-audit, during audit,
and appeal.

Most billing vendors only help after you've already received a demand. We provide three layers of protection — reducing the probability of audit targeting, managing it when it happens, and winning at the appeal stage if needed.

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Pre-audit risk assessmentWe analyze your claim history for patterns that match current CERT and OIG target areas — and fix them before they trigger a review. MIPS quality reporting is one area where documentation gaps frequently create audit exposure.

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Documentation alignmentWe align your clinical documentation to coding standards so every record supports the claim exactly as submitted.

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ADR response managementWe prepare complete Additional Documentation Request responses with clinical narrative, supporting records, and payer-specific formatting.

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Redetermination & reconsideration appealsWe draft and submit MAC-level redeterminations and QIC reconsiderations with full clinical justification packages.

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ALJ hearing preparation & representationWhen prior levels fail, the ALJ stage offers the highest reversal rates — and we prepare every case to succeed there.

Every audit type,every level of appeal.

RAC (Recovery Audit Contractor)

UPIC (Unified Program Integrity Contractor)

MAC Targeted Reviews

Pre-audit, during audit,and appeal.

Received an audit notice?Don't respond alone.

Every audit type,
every level of appeal.

Pre-audit, during audit,
and appeal.

Received an audit notice?
Don't respond alone.